Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, The Netherlands.
Int Arch Occup Environ Health. 2011 Oct;84(7):825-37. doi: 10.1007/s00420-011-0637-4. Epub 2011 Apr 9.
Mental health problems are associated with sickness absence (SA). The present study aimed at establishing which symptoms-distress, depression, anxiety, or somatization-at which symptom levels were associated with SA frequency and duration. Moreover, a number of possible confounders or effect modifiers were taken into account.
A survey was completed by 3,678 employees of a large Dutch telecom company. Symptoms were measured using the Four-Dimensional Symptom Questionnaire (4DSQ). SA data were registered by the company's occupational health service during the 12 months' period following the survey. Poisson regression was used to analyze the number of SA spells (SA frequency). Negative binomial regression was used to analyze the total number of SA days (SA duration).
In the bivariate analyses distress, depression, anxiety, and somatization impacted on SA frequency and duration. In the multivariate analyses, anxiety and depression turned out not to be directly associated with SA, suggesting that the effect of anxiety and depression was due to the association between anxiety/depression and distress/somatization. Regarding the SA frequency, the rate ratio for 'subclinical' distress was 1.13 (95% CI 1.03-1.25), for 'clinical' distress 1.26 (1.08-1.47), for 'subclinical' somatization 1.34 (1.23-1.46), and for 'clinical' somatization 1.69 (1.46-1.95). Regarding the SA duration, the count ratio for 'subclinical' distress was 1.15 (95% CI 0.91-1.44), for 'clinical' distress 1.50 (1.04-2.16), for 'subclinical' somatization 1.34 (1.10-1.64), and for 'clinical' somatization 1.45 (1.04-2.03).
Somatization and distress are key to understand why depression and anxiety are related to SA.
心理健康问题与病假（SA）有关。本研究旨在确定哪些症状-痛苦、抑郁、焦虑或躯体化-在何种症状水平上与 SA 的频率和持续时间相关。此外，还考虑了一些可能的混杂因素或效应修饰剂。
一项针对一家大型荷兰电信公司的 3678 名员工的调查完成了。使用四维度症状问卷（4DSQ）测量症状。SA 数据由公司的职业健康服务机构在调查后的 12 个月内登记。泊松回归用于分析 SA 发作次数（SA 频率）。负二项回归用于分析 SA 总天数（SA 持续时间）。
在单变量分析中，痛苦、抑郁、焦虑和躯体化影响 SA 的频率和持续时间。在多变量分析中，焦虑和抑郁与 SA 没有直接相关，这表明焦虑和抑郁的影响是由于焦虑/抑郁与痛苦/躯体化之间的关联。关于 SA 频率，“亚临床”痛苦的比率比为 1.13（95%CI 1.03-1.25），“临床”痛苦为 1.26（1.08-1.47），“亚临床”躯体化为 1.34（1.23-1.46），“临床”躯体化为 1.69（1.46-1.95）。关于 SA 持续时间，“亚临床”痛苦的计数比为 1.15（95%CI 0.91-1.44），“临床”痛苦为 1.50（1.04-2.16），“亚临床”躯体化为 1.34（1.10-1.64），“临床”躯体化为 1.45（1.04-2.03）。
躯体化和痛苦是理解为什么抑郁和焦虑与 SA 相关的关键。
